Until recently this species was regarded as subspecies of Pyrrhosoma nymphula. Kalkman & Lopau (2006) illustrated the differences between the two taxa and confirmed that they should be treated as valid species.

P. elisabethae is known from less than 10 locations, several of which are confirmed to have become extinct or are only based on old records (more than 20 years old). All locations are confined to the Greek island of Kérkira, Peloponnese and northwest Greece and southern Albania (area of occupancy is less than 10 km²). The population is split into three main areas that are fragmented. Habitat requirements are poorly known but up to date it was found in the immediate vicinity of well-vegetated streams. Such habitats are heavily influenced by the climatic changes and development of tourism and human settlements. It is clear that this is one of the most threatened damselfly species in Europe.

The species meets the threshold requirements for Critically Endangered under criterion B. It is also projected that the population is likely to decline by 30-50% over the next 10 years (VU A4c).

Pyrrhosoma elisabethae is endemic to the southern Balkans. It is known from eight localities from Peloponnese, Kérkira and southern Albania (Kalkman and Lopau 2006) and from one record in northwest Greece (Muranyi 2007).

Most localities have been visited only once or twice and information on the size of the populations is scarce. The limited information suggest that the species occurs in low to very low densities and some of the known populations might have less than a hundred adult individuals per year.

Information on habitat requirements is poor. The following notes on the habitat are available:- Corfu: a ditch and along a slow flowing river in the coastal plains- Peloponnese: brooklets with clear, cool water and rich vegetation and a well-vegetated brook

Based on this and on some pictures of the habitat it can be concluded that the species mainly occurs in brooks and sometimes in rivers with abundant aquatic vegetation. It is likely that the species cannot survive in habitats that fall dry during hot summers. It is not clear if the species can reproduce in standing waters.

The management of brooks in Albania and Greece is very poor. The natural situation of brooks is, in many cases, destroyed for irrigation purposes and concrete channels often replace brooks. Further threats are water pollution and too intensive management (e.g. the clearing of all riparian vegetation). In recent years climate change has become one of the main threats and during recent hot and dry summers several brooks in Greece where found to be dry. Information on this for the sites where the species occurs is lacking, it is however likely that at least some of its populations were affected by the dry periods. Two known populations were visited in 2007: one population was found extinct and at the other site the habitat was degraded and only one male was found.

This is one of the most threatened European dragonflies and conservation actions are needed immediately. First action to be undertaken is to visit all known localities to establish if the species survives, to gather detailed information on its habitat and to map local threats. Based on this information locations can be selected where the species might occur for further fieldwork. For the known populations a species action plan needs to be created. This needs to be done on population level and in close co-operation with local authorities and landowners. It is mandatory that several of the locations should be included in nature reserves.